Chromomycosis is a rare fungal infection of the skin of patients with a normal immune system. It happens usually in the tropics or subtropics. The entry into the body occurs through small skin wounds in the feet, lower legs or other skin areas. As the fungi that cause chromomycosis contain melanin, which is pigment laden, the skin eruptions containing the fungi also appear dark and pigmented. A number of different species such as Bipolaris, Cladosporium, Phialophora and many others cause chromomycosis.
Signs and Symptoms
The initially isolated skin lesion enlarge, ulcerate, multiply and for between 4 and 15 years stay locally confined to an extremity or a regional area of skin. Here is a picture of a male with chromomycosis (thanks to www.globalskinatlas.com for this link) of the lower leg.
The underlying lymph vessels and lymph glands get also infected and this can lead to edematous swelling of the regional area. The affected skin is very itchy. Scratching only helps to infect the neighboring skin. Eventually cauliflower like skin surface develops that is pigmented compared to the normal skin. Bacterial superinfection of scratched open lesions can complicate the clinical picture.
The diagnosis can be difficult and culture methods and biopsy and histological analysis are the only reliable means to confirm the clinical suspicion. A skin specialist likely should be consulted.
Itraconazole (brand name: Sporanox) is the treatment of choice, but will not heal all of the cases. The specialist may use other agents such as flucytosine (brand name: Ancobon) as additional therapy. If antifungal therapy does not lead to a cure, the physician may have to use surgical excision as an additional mode of therapy.
1.The Merck Manual, 7th edition, by M. H. Beer s et al., Whitehouse Station, N.J., 1999. Chapter 158.
2.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 113.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 164.
4.David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.